Systematic ImprovementVTE

1

Courtesy Reminders: •Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) •Please do not take calls and place the phone on HOLD during the presentation.

Travis DollakImprovement Advisor

WHA

Poll Question #1

Which of the following Action Items did you complete for June?

a. Submit Baseline Datab.Hold a Team Meetingc. View Science of Safety Videod.Review Quality Center Resources

2

Today’s Call• Past 30 days• Staff Safety Assessment• Intervention Analysis • Model for Improvement (including PDSA and

Small Tests of Change)• Next 30 days– Assessing your Change Ideas– AIM Statements

3

Last Month’s Survey Results

4

ACTION ITEMSSubmit Baseline Data

Hold an initiative team meeting

View Science of Safety Video

Review Quality Center

5

What went well? What could be improved?

Past 30 Days

Science of Safety Recipe

• Educate on the Science of Safety• Identify Defects (Staff safety assessment)*• Learn from Defects• Implement Teamwork & Communication

Tools

6

What is a Defect?Simple Answer: Anything you do not want to have happen again.

• VTE risk assessment is not routine or standard• Noncompliance with prophylaxis exists• Protocols differ among orthopedics, surgery, and medicine.• Unnecessary immobility occurs because of excessive

sedation, central lines, catheters, etc.• VTE and bleeding risks change, but there is no routine or

standard reassessment.• Widely different impressions are held from when it is safe to

start anticoagulation per-procedure and post-trauma.

7

Identifying Defects

• Review error reports, liability claims, sentinel events

• Ask staff how the next patient will be harmed

8

The Staff Safety Assessment

How will the next patient be harmed?

One way to make harm visible– get staff thinking about safety and how to improve it

Have team review responses and suggestions

9

Action Item #1 – Staff Safety Assessment

Just two (2) very important questions for any clinical unit:Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event.

Please describe what you think can be done to prevent or minimize this harm.

Thank you for helping improve safety in our workplace!

10

Available in the Webinar Folder on the Quality Center

Poll Question # 2

Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event.

(Free Text Response)

11

Options for Collecting AssessmentsWhat Team Leaders can do:1. Hand out a Staff Safety Assessment form to all staff,

clinical and non-clinical, in the unit. 2. Assure participants of their confidentiality.3. Establish a collection box or envelope OR alternatively

use an on-line survey tool.4. Set an end date for compiling all the responses.

12

Every improvement is a change, but every change is not always an improvement

13

Intervention Analysis

• Analyze feasibility of the ideas from the Staff Safety Assessment

• Analyze feasibility of secondary drivers (from literature)

14

Poll Question # 2 Responses

Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event.

15

Prioritizing Your Ideas• Review responses from Staff Safety Assessment• Categorize them based on primary driver

Primary Driver Staff Safety AssessmentEffective Risk Stratification I

Standardized Care Processes IIIIIII

Decision Support (or Smart Use of Technology)

IIII

Prevention of Failure III

Identification and Mitigation of Failure

II

Other

16

Prioritizing Your Interventions

Low Impact

High Impact

Difficult to Implement

Easy to Implement

17

Action Item #2 – Assess and select an intervention using assessment tools

Considerations:• How would this intervention work on the

unit?• Who would be willing to try the intervention?• Could you try this within the next three days?

18

Questions on How to Assess Interventions?

19

20

Testing ideas before implementing changes

Change ideas

Measurement

Aims

Systematic Improvement

AIM Statement –What are we trying to accomplish?

• By when?• What?• Who?• How much?

Sample Aim Statements• Wisconsin Hospitals will reduce the

incidence of hospital-acquired VTE by 50% by December 31, 2013.

• By July 1, 2012, 95% of hospitalized patients in our unit will receive VTE prophylaxis as defined by protocols and according to a patient’s assessed status of VTE risk or prophylaxis contraindications based on the VTE prophylaxis assessment tool. Contraindications will be clearly documented in the medical record for 95% of the cases in which VTE prophylaxis is not ordered.

21

Evaluate these AIM Statements• The med/surg unit will reduce the incidence of

VTE by 30%• 5 North will improve the VTE risk assessment

tool before January 2013• The pilot unit will achieve zero VTE incidences

over a 5 month period by September 2013

22

Action Item #3 – Develop Your AIM Statement

23

24

Testing ideas before implementing changes

Change ideas

Measurement

Aims

Systematic Improvement

Measurement

Annotated Run Chart – plot small samples frequently over time.

25

Time (e.g., Month)Time (e.g., Month)

ObservedDataValue

(e.g.,med errors)

ObservedDataValue

(e.g.,med errors)

TOPIC SPECIFICTOPIC SPECIFICTOPIC SPECIFICTOPIC SPECIFIC

“In God we trust.All others bring data.”

W. E. Deming

VTE Process MeasuresAction Item #4: Submit Data

• Percent of patients screened on admission using VTE risk assessment tool OR• Prevalence of appropriate VTE

prophylaxis

* Minimum of 20 patients/month for either measure

26

From Practice to Application:What to do next?

Engaging front-line staff in innovation and quality improvement

26

28

Testing ideas before implementing changes

Change ideas

Measurement

Aims

Systematic Improvement

Change Ideas

To be considered a real test…• Test was planned, including a plan for

collecting data• Plan was carried out and data was collected• Time was set aside to analyze data and study

the results• Action was based on what was learned

29

Repeated Use of the PDSA Cycle

30

Changes That Result in

Improvement

Implementation of Change

Hunches Theories Change Ideas

A PS D

APS

D

A P

S DD S

P ADATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

IHI – Adapted from “The Improvement Guide” by Lloyd Provost

PDSA Cycle for Learning and Improving

31

ActWhat changes

are to be made?Next cycle?

PlanObjective, questions

and predictions (why)

Plan to carry out the cycle (who, what, where, when)

Study

Complete the analysis of the data

Compare data to predictions

Summarize what was learned

Do

Carry out the planDocument problemsand unexpectedobservationsBegin analysis of the data

Action Item #5 – Test an Intervention

Rule of 1• Apply the Rule of 1: try the intervention with one

patient, one nurse, one hour, one room.• Expand the participants systematically three nurses, six

patients, one shift.• The goal is to have at least 20% of those doing the

work to have a chance to try it before it because a standard.

• Topic Example

32

Action Item #6 – Make a Prediction and Measure

Benefits:• Know what you are doing is making an impact• Early indicator that you may be getting off

track• Opportunity to identify obstacles• Answers the question: “Can we rapidly adopt

this practice?”

33

Keep Track of Your FindingsTEST PREDICTION RESULTS

Try simplified risk assessment tool on one patient

Speed up process, clearer instructions for prophylaxis

Add contraindications to order sheet

Increase likelihood contraindications are identified

34

The Next 30 DaysACTION ITEMSStaff Safety AssessmentAssess your interventionsDevelop an Aim StatementTest ONE interventionMake a predictionSubmit Outcome and Process Measure

35

Tools available on WHA Quality Center:• Assessment Toolkit • Aim Statement Template• Data Portal

Thank You!

Questions?

36